How Politicians Are Making Safe Abortions Nearly Inaccessible in the South

Is it unduly burdensome to have to travel 300 miles to obtain a simple, incredibly common medical procedure? To have to cross state lines?

That's the question American courts are set to address as anti-abortion groups double down on their strategy of restricting abortion to the point of total inaccessibility. The Louisiana State Legislature just passed a bill that may shutter most of the state's abortion clinics and in turn force women to drive for hours to legally terminate a pregnancy. Louisiana Governor Bobby Jindal indicated he will sign the bill into law.

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The Louisiana bill requires doctors performing abortions to have admitting privileges at nearby hospitals, which seems to be the abortion restriction of choice in the South these days (although it's by no means the only one anti-abortion politicians are using). Proponents claim the goal is to protect the health of the pregnant woman, which sounds reasonable enough, but in reality, admitting privileges are both totally unnecessary and routinely denied to abortion providers anyway.

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Let's talk about the health component first: Though the anti-abortion movement refuses to acknowledge it, abortion remains one of the safest medical procedures around. Complications are extremely rare — less than one-half of one percent of abortion procedures have the kind of major complications that require a trip to the hospital. First-trimester abortions, which account for almost 9 in 10 abortions performed in the U.S., have a mortality rate of 4 in a million — the death rate from taking aspirin is higher. An American woman is 14 times more likely to die during childbirth than she is from an abortion. In the rare instances where serious complications from abortion do arise, hospital emergency rooms accept the patient without issue — no admitting privileges necessary.

Both the American Medical Association and the American College of Obstetricians and Gynecologists oppose laws mandating admitting privileges. And contrary to the "health of the woman" argument, it's worth noting that the recent admitting privileges laws specifically target abortion clinics but not other medical providers. In many states, including Texas, admitting privileges are not required for ambulatory surgical centers that do not provide abortions.

Getting those privileges is also a long and arduous process, and simply submitting an application along with the right credentials does not ensure you will get them. Hospitals in Mississippi refused to even give an application for admitting privileges to doctors who work at the one abortion clinic left in that state. And a Texas OB/GYN with 40 years of experience told Cosmopolitan.com that he was denied privileges in the Rio Grande Valley. Many hospitals also require that doctors with admitting privileges admit a certain number of patients to the hospital every year, but because abortion is so safe that not very many women need to be admitted to the hospital after the procedure, most abortion providers cannot meet that requirement.

So if admitting privileges don't make abortion any safer, if medical professionals oppose them, and if they aren't actually necessary to get a patient admitted to a hospital, why require them?

"These incremental laws are part of a greater strategy to end abortion in our country," Tanya Britton, a board member for Pro-Life Mississippi, told The New York Times. "It's part of it, and one day, our country will be abortion-free."

Today, no country on earth is abortion-free. But safety varies widely, depending on legality and accessibility. Restrictive abortion laws do not correlate with a lower abortion rate, but they do correlate with higher instances of abortion-related injury and death — that is, when you make abortions illegal or difficult to obtain, you don't make them significantly less common, but you do make them much less safe. The fact that abortion restrictions lead to worse women's health outcomes, not better ones, and puts women's physical safety at risk casts an Orwellian chill on Gov. Jindal's endorsement of the bill as one that "gives women the health and safety protections they deserve."

Similar restrictions — and many other anti-abortion laws — have passed in Texas, Mississippi, and Alabama, and a proposed admitting privilege law is nearing the end of its path through the legislature in Oklahoma. So far, only Texas has implemented the admitting privileges requirement, and the laws are working: a third of all abortion clinics in that state have closed, women report going to Mexico to terminate pregnancies, and hospitals have even tried to rescind existing admitting privileges for abortion providers.

Reproductive rights groups are involved in legal battles to prevent other states from implementing similar legislation. In Mississippi, the admitting privileges requirement would shut down the only abortion clinic left in the entire state. Similarly devastating effects will reach Louisiana if this law is put in place. Some doctors already fly into the state to perform abortions, since there are few in-state providers. And as it stands, the only two abortion clinics in Louisiana who employ doctors with admitting privileges are both in Shreveport, more than 300 miles — a five-hour drive — from New Orleans.

"We are basically going back to a situation in this country that looks like the landscape before Roe v. Wade, where some women do not have access to abortion," Brigitte Amiri, senior staff attorney at the ACLU's Reproductive Freedom Project, told Cosmopolitan.com. "If you are wealthy and live in a city, you will be able to get access. But that's not what the constitutional guarantee of abortion access is about."

At issue in the legal challenges from groups including the ACLU, Planned Parenthood, and the Center for Reproductive Rights is the question of whether admitting privileges pose an "undue burden" to women seeking abortions. More than 20 years ago, the Supreme Court decided a case, Planned Parenthood v. Casey, that upheld abortion as a constitutional right and also addressed just how restrictive laws regulating abortion could be to still pass constitutional muster. The court upheld a series of rules, including parental notification and 24-hour waiting periods, while striking down a spousal notification provision as unduly burdensome. Now when states pass and pro-choice groups challenge abortion restrictions, courts look at the "undue burden" question.

To do that, they first ask whether the law furthers a state interest, and then, if it does, whether the law has "the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus." It's hard to argue that having to drive hundreds of miles to get a medical procedure is not a substantial obstacle, but some Fifth Circuit judges believe exactly that, reasoning, in a case challenging admitting privileges in Texas, that a three-hour drive isn't too much of a burden. Given that previous decision, there's a real threat these laws could remain in place.

The burden grows larger with every neighboring state that passes these laws. As it stands, many women have to cross state lines to terminate pregnancies when their home state makes abortions tougher to get and as fewer abortion clinics remain in operation. In a court case challenging the Mississippi law, the state argued that women could travel to Louisiana, Tennessee, and Alabama. But with this law that would force clinics to close in Louisiana, the options become even more limited. With another law likely coming in Oklahoma, abortion is rapidly becoming nearly inaccessible for women across a broad stretch of the American South.

At the same time Louisiana is restricting abortion access, they're also scaling back the very measures that prevent abortions from happening in the first place — a bill that would have provided comprehensive sexual health education for Louisiana students recently failed in committee.

"This is a very one-sided conversation the legislature is having right now," Elizabeth Nash, states issues manager of the Guttmacher Institute, told Cosmopolitan.com. "It's not serving a public health purpose, and it's not serving the women and families of Louisiana."